RESUMO
OBJECTIVES: Determine distribution, job description, and board certification status of the University of Puerto Rico Emergency Medicine Program (UPREMP) graduates. METHODS: A telephone survey was performed of all UPREMP graduates from 1995 to 2007, asking for the following information: practitioner or non practitioner, working place, job description (e.g. Fellow, Staff or Emergency Room Directors), and board certification status. In cases in which the person could not be reached by phone, the last information available at the UPREMRP department was used to fill the survey. The board certification was verified using The American Board of Medical Specialties web site. Worksheets were used to organize data and then analyzed statistically with Excel 2003. RESULTS: Of the 102 graduates, 59% are males and 41% are women, 50% are board certified, 30% are not and 20% are pending certification. Of the female graduates, 77% are board certified, while only 60% of male graduates are board certified. Sixty percent (60%) of the graduates stayed in Puerto Rico and 40% moved to the United States. The distribution of graduates among PR senatorial districts (counties) was as follows: San Juan 22%, Bayamón 17%, Arecibo 0%, Mayagüez 5%, Ponce, 23%, Guayama 6%, Humacao 12% and Carolina 20%. The job description among graduates was: 54% full time Emergency Department (ED) Staff, 3% part time ED staff, 23% academic faculty, 10% directors, 5% fellows and 5% other. CONCLUSION: From our study, we can conclude that although the vast majority of UPREMP graduates stay in PR after graduation, most of them practice in four of the eight PR senatorial districts. Further studies are needed to determine: the reasons why graduates have moved to the mainland US and for working mostly in four PR senatorial districts.
Assuntos
Medicina de Emergência/educação , Certificação , Feminino , Humanos , Masculino , Porto Rico , Faculdades de Medicina , UniversidadesRESUMO
BACKGROUND: In trauma patients surviving their initial injuries, infectious complications and multiple organ failure represent the major causes of death after the first 72 hours. Critically injured trauma patients frequently have bacteria recoverable simultaneously from multiple culture sites; the clinical significance of this event is unknown. The objective of this study was to identify the association between growth patterns of multiple site cultures and mortality among critically injured trauma patients. METHODS: We performed a retrospective chart review collecting demographic and medical data on admissions to a state-designated Level I trauma center from April 2000 to December 2002. The inclusion criteria were age >17 years, admission to the trauma intensive care unit (TICU), and simultaneous sampling of blood, sputum, and urine in the setting of fever of undetermined origin or alteration in the white blood cell count. Four mutually exclusive groups were developed according to the number of positive culture sites. We used standard statistical analysis and multivariate logistic regression. RESULTS: During the study period, 3,402 patients were admitted to the trauma service of whom 124 met the inclusion criteria. Eighty percent of these (99) were male, and the average age was 41 years. The median TICU stay was 17 days. The mortality rate was 24.2% (30 nonsurvivors). The survivors and non-survivors were comparable in injury severity score (ISS), initial base deficit, initial hematocrit, initial blood pressure, and hospital length of stay (p > 0.05), whereas age (p = 0.03), female sex (p = 0.04), and TICU stay (p < 0.01) were higher among non-survivors. More non-survivors showed growth of microorganisms in simultaneous blood, sputum, and urine cultures (p = 0.02). By multivariate analysis, adjusting for age, sex, and TICU length of stay, patients with growth of microorganisms in simultaneous cultures (blood, sputum, and urine) had a 3-fold greater mortality rate (OR, 3.20; 95% CI 1.05, 9.73). CONCLUSIONS: In this group of patients, growth of bacteria in simultaneous cultures was associated with higher mortality-a factor that may be considered a poor prognostic indicator. This factor requires further studies to explore the relation with survival in critically injured patients.